To the Editor: Dr Morrow and colleagues1 studied the prognostic value of serial testing of B-type natriuretic peptide (BNP) in patients with unstable coronary artery disease. I am not certain of the validity of their conclusion that changes in BNP levels are associated with long-term clinical outcomes and may provide enhanced decision making in these patients.
A crucial issue is whether BNP measurement provides important incremental prognostic information beyond that available to a clinician from a patient interview, such as an assessment of health status (symptoms, functional status, and quality of life). Level of BNP could be little more than a costly surrogate measure of health status that merely identifies those with a greater burden of heart disease. This cannot be determined from this article because the results were not adjusted for health status.
Level of BNP is correlated with health status,2 and health status3 - 4 and BNP1 have been separately linked with mortality. Spertus et al5 found that serial health status measurement provides superior sensitivity to clinical change compared with serial BNP measurement and other techniques in the setting of heart failure. There may be no advantage of serial BNP measurements over serial histories and physical examinations in guiding decision making.
In addition, because the analysis by Morrow et al reduced the continuous variable BNP to a dichotomous variable (high vs low), it is not clear how sensitive BNP values truly are to clinical change. For example, if BNP levels of 90 pg/mL pose the same risk as 900 pg/mL, serial BNP may not be a robust discriminator of patient outcomes.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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